Dynapenia and sarcopenia: association with the diagnosis, duration and complication of type 2 diabetes mellitus in ELSA-Brasil.

Sarcopenia (the loss of muscle mass, strength and skeletal muscle function) increases mortality and the risk of hospitalization in the older population. Although it is known that older adults with type 2 diabetes mellitus (T2DM) have a higher risk of dynapenia and sarcopenia, few studies have investigated these conditions in middle-aged populations. The objective of this study was to investigate whether T2DM, its duration, the presence of albuminuria, and glycemic control are associated with sarcopenia and its components in adults. The cross-sectional analysis was based on data from visit 2 of the Brazilian Longitudinal Study of Adult Health (2012-2014). The 2018 European Working Group on Sarcopenia in Older People criteria were used to define dynapenia, low appendicular muscle mass (LAMM), and sarcopenia (absent/probable/confirmed). The explanatory variables were: T2DM; duration of T2DM; T2DM according to the presence of albuminuria; and glycemic control (HbA1C < 7%) among people with T2DM. A total of 12,132 participants (mean age = 55.5, SD: 8.9 years) were included. The odds ratio for LAMM was greater among those with T2DM, T2DM duration from 5 to 10 years, and T2DM without albuminuria. Chances of dynapenia were higher among those with T2DM, T2DM duration > 10 years, and T2DM with and without albuminuria. The variables T2DM, T2DM ≥ 10 years, and T2DM with albuminuria increased the odds of probable sarcopenia, and T2DM duration from 5 to 10 years increased the odds of confirmed sarcopenia. The results support the importance of frequently monitoring the musculoskeletal mass and strength of individuals with T2DM to prevent sarcopenia and related outcomes.

Dynapenia and sarcopenia: association with the diagnosis, duration and complication of type 2 diabetes mellitus in ELSA-Brasil / Dinapenia e sarcopenia: associação com o diagnóstico, duração e complicações de diabetes mellitus tipo 2 no ELSA-Brasil / Dinapenia y sarcopenia: asociación con el diagnóstico, duración y complicaciones de la diabetes mellitus tipo 2 en ELSA-Brasil

Abstract: Sarcopenia (the loss of muscle mass, strength and skeletal muscle function) increases mortality and the risk of hospitalization in the older population. Although it is known that older adults with type 2 diabetes mellitus (T2DM) have a higher risk of dynapenia and sarcopenia, few studies have investigated these conditions in middle-aged populations. The objective of this study was to investigate whether T2DM, its duration, the presence of albuminuria, and glycemic control are associated with sarcopenia and its components in adults. The cross-sectional analysis was based on data from visit 2 of the Brazilian Longitudinal Study of Adult Health (2012-2014). The 2018 European Working Group on Sarcopenia in Older People criteria were used to define dynapenia, low appendicular muscle mass (LAMM), and sarcopenia (absent/probable/confirmed). The explanatory variables were: T2DM; duration of T2DM; T2DM according to the presence of albuminuria; and glycemic control (HbA1C < 7%) among people with T2DM. A total of 12,132 participants (mean age = 55.5, SD: 8.9 years) were included. The odds ratio for LAMM was greater among those with T2DM, T2DM duration from 5 to 10 years, and T2DM without albuminuria. Chances of dynapenia were higher among those with T2DM, T2DM duration > 10 years, and T2DM with and without albuminuria. The variables T2DM, T2DM ≥ 10 years, and T2DM with albuminuria increased the odds of probable sarcopenia, and T2DM duration from 5 to 10 years increased the odds of confirmed sarcopenia. The results support the importance of frequently monitoring the musculoskeletal mass and strength of individuals with T2DM to prevent sarcopenia and related outcomes.

Resumo: A sarcopenia (perda de massa muscular, força e função muscular esquelética) aumenta a mortalidade e o risco de hospitalização em idosos. Idosos com diabetes mellitus tipo 2 (DMT2) apresentam risco elevado de desenvolver dinapenia e sarcopenia, mas poucos estudos investigaram populações de meia-idade. O objetivo foi investigar se DMT2, sua duração, a presença de albuminúria e o controle glicêmico estão associados à sarcopenia e seus componentes em adultos. Análise transversal baseada nos dados da segunda visita do Estudo Longitudinal de Saúde do Adulto (2012-2014). Os critérios do European Working Group on Sarcopenia in Older People [Grupo de Trabalho Europeu sobre Sarcopenia em Pessoas Idosas] de 2018 foram usados para definir dinapenia, baixa massa muscular apendicular e sarcopenia (ausente/provável/confirmada). As variáveis explicativas foram: DMT2; duração do DMT2; DMT2 de acordo com a presença de albuminúria; e controle glicêmico (HbA1c < 7%) entre pessoas com DMT2. Foram incluídos 12.132 participantes (idade média de 55,5; DP: 8,9 anos). A razão de chances para baixa massa muscular apendicular foi maior entre pessoas com DMT2, duração do DMT2 entre 5 e 10 anos e DMT2 sem albuminúria. As chances de dinapenia foram maiores entre pessoas com DMT2, duração do DMT2 > 10 anos e DMT2 com e sem albuminúria. DMT2, DMT2 ≥ 10 anos e DMT2 com albuminúria aumentaram as chances de sarcopenia provável e duração do DMT2 entre 5 e 10 anos aumentaram as chances de sarcopenia confirmada. Os resultados reforçam a importância do monitoramento frequente da massa e da força muscular em indivíduos com DMT2 para prevenir a sarcopenia e desfechos relacionados.

Resumen: La sarcopenia (pérdida de masa muscular, fuerza y función muscular esquelética) aumenta la mortalidad y el riesgo de hospitalización en ancianos. Los ancianos con diabetes mellitus tipo 2 (DMT2) presentan un mayor riesgo de sufrir dinapenia y sarcopenia, pero pocos estudios han investigado poblaciones de mediana edad. El objetivo fue investigar si la DMT2, su duración, la presencia de albuminuria y el control glucémico están asociados con la sarcopenia y sus componentes en adultos. Análisis transversal basado en los datos de la visita 2 del Estudio Longitudinal de Salud del Adulto en Brasil (2012-2014). Se utilizaron los criterios del European Working Group on Sarcopenia in Older People [Grupo de Trabajo Europeo sobre Sarcopenia en Personas Mayores] del 2018 para definir dinapenia, baja masa muscular apendicular y sarcopenia (ausente/probable/confirmada). Las variables explicativas fueron las siguientes: DMT2; duración de la DMT2; DMT2 según la presencia de albuminuria; y control glucémico (HbA1c < 7%) entre personas con DMT2. Se incluyeron 12.132 participantes (edad media = 55,5, DE: 8,9 años). La razón de probabilidades de masa muscular apendicular baja fue mayor entre personas con DMT2, duración de la DMT2 entre 5 y 10 años y DMT2 sin albuminuria. Las probabilidades de dinapenia fueron mayores entre las personas con DMT2, duración de la DMT2 > 10 años y DMT2 con y sin albuminuria. Las condiciones de DMT2, DMT2 ≥ 10 años y DMT2 con albuminuria aumentaron las probabilidades de sarcopenia probable y la duración de la DMT2 entre 5 y 10 años las probabilidades de sarcopenia confirmada. Los resultados refuerzan la importancia del monitoreo frecuente de la masa y de la fuerza musculoesquelética en individuos con DMT2 para prevenir la sarcopenia y los desenlaces relacionados.

Ultra-processed foods: Cross-sectional and longitudinal association with uric acid and hyperuricemia in ELSA-Brasil.

BACKGROUND AND AIMS: Food intake influences uric acid (UA) levels and hyperuricemia (HU), but evidence on the role of ultra-processed foods (UPFs) are scarce. The association between UPFs consumption and (1) HU prevalence and UA levels; (2) HU cumulative incidence; and (3) UA level change over a 4-year period was investigated. METHODS AND RESULTS: Cross-sectional and longitudinal analyses were performed using baseline (2008-2010, aged 35-74 years) and second visit (2012-2014) data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Participants with glomerular filtration rate <60 mL/min/1.73 m2, bariatric surgery, implausible caloric intake, and using urate-lowering therapy (ULT) at baseline were excluded (all analyses). Participants with HU at baseline were excluded from longitudinal analyses. UPFs consumption was assessed using a food frequency questionnaire (FFQ) and categorized by the NOVA classification system (100 g/day). HU was defined as UA≥6.8 mg/dL. Linear, logistic, and mixed-effect linear regressions investigated the associations between UPFs consumption and UA/HU, adjusted for covariates. The final samples included 13,923 (cross-sectional) and 10,517 (longitudinal) individuals. The prevalence of HU was 18.7%, and the cumulative incidence was 4.9%. Greater UPFs consumption was associated with a greater prevalence of HU (OR:1.025 95%CI: 1.006; 1.044) and higher UA levels (ß:0.024 95%CI: 0.016; 0.032). Every additional consumption of 100 g/day of UPFs raised the 4-year cumulative incidence of HU by 5.6% (95%CI: 1.021; 1.092). However, UPFs were not associated with the pace of UA level changes during the study period. CONCLUSION: The present study shows that greater UPFs consumption is associated with another deleterious health consequence: higher UA levels and the risk of having HU.

Birth weight is related with bone mineral content in adulthood: results of ELSA-Brasil.

OBJECTIVE: To investigate the association between birth weight and bone mineral content (BMC), and whether this relationship differs between men and women. METHODS: A total of 10,159 participants from the ELSA-Brasil cohort were eligible for this analysis. The outcome was the z-score of the ratio BMC (kg)/height (m). The exposure was the low birth weight (< 2.5kg). The magnitude of the associations was estimated by mean differences and their respective 95% confidence intervals (95%CI) using linear regression. All analyses were presented for the total population and stratified by sex. RESULTS: Most were women (54.98%), and the mean age was 52.72 years (SD ± 6.6). In the crude model, we observed that low birth weight was associated with a lower mean BMC/height z-score, compared to adequate birth weight (mean difference: -0.30; 95%CI: -0.39 to -0.21), and this effect was stronger in men (mean difference: -0.43; 95%CI: -0.56 to -0.30) than in women (mean difference: -0.31; 95%CI: -0.44 to -0.19). After adjusting for age, sex per total population, race/skin color, maternal education, individual education, and current weight, there was a considerable reduction in the magnitude of the association (total population: -0.10; 95%CI: -0.14 to -0.06; men: -0.13; 95%CI: -0.21 to -0.06; women: -0.13; 95%CI: -0.21 to -0.05). CONCLUSION: Low birth weight is related to BMC/height z-score in both sexes with no indication of differences by sex. The magnitude of the associations was attenuated after adjustment for the current weight.

Body fat distribution and its risk for cardiovascular events in 10 years: Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Body fat distribution seems to have different effects in cardiovascular diseases (CVD). We aimed to estimate the associations between lower limbs and trunk fat ratio and the 10-year CVD risk, and isolated risk factors in men and women. A total of 10,917 participants from ELSA-Brasil were eligible for this cross-sectional study. Associations between lower limb/trunk fat ratio with the percentage of 10-year CVD risk - according to the Framingham Risk Score - and its risk factors (systolic blood pressure, total cholesterol and HDL-cholesterol, diabetes, and use of antihypertensive medication) were performed using generalized linear models, linear and logistic regressions. All analyses were stratified by gender and adjustments were made by age, self-reported skin color, educational attainment, alcohol consumption, leisure physical activity, hypolipidemic drug use and, for women, menopausal status. In this study, 55.91% were women, with a mean age of 52.68 (SD = 6.57) years. A higher lower limb/trunk fat ratio was related to lower 10-year CVD risk, as well as a reduction in systolic blood pressure, total cholesterol, and antihypertensive drug use, also an increasing HDL-cholesterol in both genders, but this relationship was stronger in women. Besides, a protective relationship to diabetes was observed in women. Higher fat accumulation in the lower body, when compared to the trunk, seems to have a lower risk of CVD and associated risk factors - even in the presence of fat in the abdominal region - with women presenting lower risks than men.

Racism and racial iniquities in poor self-rated health: the role of intergenerational social mobility in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). / Racismo e iniquidade racial na autoavaliação de saúde ruim: o papel da mobilidade social intergeracional no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil).

Blacks and Browns have major health disadvantages, are less likely to rise in the social hierarchy throughout the course of life, and pertain to lower socioeconomic levels than Whites as a result of structural racism. However, little is known about the mediating role of intergenerational mobility in the association between race/skin color and health. The aim of the present study was to investigate the association between racism and self-rated health and to verify to what extent intergenerational social mobility mediates this association. This was a cross-sectional study conducted with data from 14,386 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline (2008-2010). Maternal education, education of the participant, socio-occupational class of the head of household, and socio-occupational class of the participant were used in the indicators of intergenerational social mobility (educational and socio-occupational). Logistic regression models were used. The prevalence of poor self-rated health was 15%, 24%, and 28% among Whites, Browns, and Blacks, respectively. After adjustments for age, sex, and research center, greater chances of poor self-rated health were found among Blacks (OR = 2.15; 95%CI: 1.92-2.41) and Browns (OR = 1.82; 95%CI: 1.64-2.01) when compared to Whites. Intergenerational educational and socio-occupational mobility mediated, respectively, 66% and 53% of the association between race/color and poor self-rated health in Blacks, and 61% and 51% in Browns, respectively. Results confirm racial iniquity in self-rated health and point out that unfavorable intergenerational social mobility is an important mechanism to explain this iniquity.

Pretos e pardos apresentam grandes desvantagens de saúde, possuem menores chances de ascensão na hierarquia social no curso de vida e menores níveis socioeconômicos do que brancos como resultado do racismo estrutural. Entretanto, pouco se sabe sobre o papel mediador da mobilidade intergeracional na associação entre racismo e saúde. O objetivo do presente estudo foi investigar a associação entre racismo e a autoavaliação de saúde, e verificar em que medida a mobilidade social intergeracional media essa associação. Estudo transversal realizado com dados de 14.386 participantes da linha de base (2008-2010) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Escolaridade materna, escolaridade do participante, classe sócio-ocupacional do chefe de família e classe sócio-ocupacional do participante compuseram os indicadores de mobilidade social intergeracional (educacional e sócio-ocupacional). Modelos de regressão logística foram utilizados. A prevalência de autoavaliação de saúde ruim foi de 15%, 24% e 28% entre brancos, pardos e pretos, respectivamente. Após ajustes por idade, sexo e centro de investigação foram encontradas maiores chances de autoavaliação de saúde ruim entre pretos (OR = 2,15; IC95%: 1,92-2,41) e pardos (OR = 1,82; IC95%: 1,64-2,01) quando comparados aos brancos. A mobilidade educacional e sócio-ocupacional intergeracional mediaram, respectivamente, 66% e 53% da associação entre a raça/cor e autoavaliação de saúde ruim em pretos, e 61% e 51% em pardos, respectivamente. Resultados confirmam a iniquidade racial na autoavaliação de saúde e apontam que a mobilidade social intergeracional desfavorável é um importante mecanismo para explicar essa iniquidade.

Negros y mulatos presentan grandes desventajas de salud, poseen menores oportunidades de ascensión en la jerarquía social en el trascurso de su vida, y menores niveles socioeconómicos que los blancos, como resultado del racismo estructural. No obstante, poco se sabe sobre el papel mediador de la movilidad intergeneracional en la asociación entre racismo y salud. El objetivo de este estudio fue investigar la asociación entre racismo y autoevaluación de salud, así como verificar en qué medida la movilidad social intergeneracional interfiere en esa asociación. Se trata de un estudio transversal, realizado con datos de 14.386 participantes de la base de referencia (2008-2010) del Estudio Longitudinal de Salud de Adultos (ELSA-Brasil). La escolaridad materna, del participante, clase socio-ocupacional del jefe de familia y clase socio-ocupacional del participante compusieron los indicadores de movilidad social intergeneracional (educacional y socio-ocupacional). Se utilizaron modelos de regresión logística. La prevalencia de autoevaluación de mala salud fue de 15%, 24% y 28% entre blancos, mulatos/mestizos y negros, respectivamente. Tras los ajustes por edad, sexo y centro de investigación, se encontraron mayores oportunidades de autoevaluación de mala salud entre negros (OR = 2,15; IC95%: 1,92-2,41) y mulatos/mestizos (OR = 1,82; IC95%: 1,64-2,01), cuando se compara con los blancos. La movilidad educacional y socio-ocupacional intergeneracional mediaron, respectivamente, 66% y 53% de la asociación entre raza/color y autoevaluación de mala salud en negros, y 61% y 51% en mulatos/mestizos, respectivamente. Los resultados confirman la inequidad racial en la autoevaluación de salud y apuntan que la movilidad social intergeneracional desfavorable es un importante mecanismo para explicar esa inequidad.

Birth weight is related with bone mineral content in adulthood: results of ELSA-Brasil

ABSTRACT OBJECTIVE To investigate the association between birth weight and bone mineral content (BMC), and whether this relationship differs between men and women. METHODS A total of 10,159 participants from the ELSA-Brasil cohort were eligible for this analysis. The outcome was the z-score of the ratio BMC (kg)/height (m). The exposure was the low birth weight (< 2.5kg). The magnitude of the associations was estimated by mean differences and their respective 95% confidence intervals (95%CI) using linear regression. All analyses were presented for the total population and stratified by sex. RESULTS Most were women (54.98%), and the mean age was 52.72 years (SD ± 6.6). In the crude model, we observed that low birth weight was associated with a lower mean BMC/height z-score, compared to adequate birth weight (mean difference: −0.30; 95%CI: −0.39 to −0.21), and this effect was stronger in men (mean difference: −0.43; 95%CI: −0.56 to −0.30) than in women (mean difference: −0.31; 95%CI: −0.44 to −0.19). After adjusting for age, sex per total population, race/skin color, maternal education, individual education, and current weight, there was a considerable reduction in the magnitude of the association (total population: −0.10; 95%CI: −0.14 to −0.06; men: −0.13; 95%CI: −0.21 to −0.06; women: −0.13; 95%CI: −0.21 to −0.05). CONCLUSION Low birth weight is related to BMC/height z-score in both sexes with no indication of differences by sex. The magnitude of the associations was attenuated after adjustment for the current weight.

Body fat distribution and its risk for cardiovascular events in 10 years: Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) / A distribuição de gordura corporal está relacionada ao risco de eventos cardiovasculares em 10 anos: Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) / La distribución de la grasa corporal está relacionada con el riesgo de eventos cardiovasculares en 10 años: Estudio Longitudinal de Salud en Adultos (ELSA-Brasil)

Body fat distribution seems to have different effects in cardiovascular diseases (CVD). We aimed to estimate the associations between lower limbs and trunk fat ratio and the 10-year CVD risk, and isolated risk factors in men and women. A total of 10,917 participants from ELSA-Brasil were eligible for this cross-sectional study. Associations between lower limb/trunk fat ratio with the percentage of 10-year CVD risk - according to the Framingham Risk Score - and its risk factors (systolic blood pressure, total cholesterol and HDL-cholesterol, diabetes, and use of antihypertensive medication) were performed using generalized linear models, linear and logistic regressions. All analyses were stratified by gender and adjustments were made by age, self-reported skin color, educational attainment, alcohol consumption, leisure physical activity, hypolipidemic drug use and, for women, menopausal status. In this study, 55.91% were women, with a mean age of 52.68 (SD = 6.57) years. A higher lower limb/trunk fat ratio was related to lower 10-year CVD risk, as well as a reduction in systolic blood pressure, total cholesterol, and antihypertensive drug use, also an increasing HDL-cholesterol in both genders, but this relationship was stronger in women. Besides, a protective relationship to diabetes was observed in women. Higher fat accumulation in the lower body, when compared to the trunk, seems to have a lower risk of CVD and associated risk factors - even in the presence of fat in the abdominal region - with women presenting lower risks than men.

A distribuição de gordura no corpo parece ter efeitos diferentes nas doenças cardiovasculares (DCV). Objetivou-se estimar as associações da razão de gordura entre membros inferiores e tronco com o risco de DCV em 10 anos e os fatores de risco independentes em homens e mulheres. Um total de 10.917 participantes do ELSA-Brasil eram elegíveis para este estudo transversal. As associações da razão de gordura entre os membros inferiores e tronco com o percentual de risco de DCV em 10 anos, de acordo com a Escala de Risco de Framingham, e os respectivos fatores de risco (pressão arterial sistólica, colesterol total e HDL colesterol, diabetes e uso de medicação anti-hipertensiva), foram avaliados com modelos lineares generalizados, lineares e de regressão logística. Todas as análises foram estratificadas por sexo, e os ajustes foram feitos por idade, raça/cor, escolaridade, consumo de álcool, atividade física, uso de medicação hipolipemiante e, para as mulheres, estado de menopausa. Na amostra do estudo atual, 55,91% eram mulheres, com média de idade de 52,68 anos (DP = 6,57). A maior diferença entre a gordura dos membros inferiores e tronco foi associada com menor risco de DCV em 10 anos e com redução na pressão arterial sistólica, colesterol total e uso de medicação anti-hipertensiva, assim como um aumento no HDL colesterol em ambos os sexos (mas essa correlação foi mais forte em mulheres). Além disso, foi observada uma relação protetora contra diabetes, apenas em mulheres. O acúmulo maior de gordura nos membros inferiores, comparado com o tronco, parece estar associado a um risco menor de DCV e aos fatores de risco, mesmo na presença de gordura na região abdominal, e esse efeito é mais forte nas mulheres que nos homens.

Las distribuciones de grasa corporal parecen tener diferentes efectos en las enfermedades cardiovasculares (ECV). Nuestro objetivo fue estimar las asociaciones entre extremidades inferiores/ratio de grasa troncal y el riesgo de ECV a los 10 años, y sus factores de riesgo aislados, en hombres y mujeres. Un total de 10.917 participantes de ELSA-Brasil fueron elegibles para este estudio transversal. Las asociaciones de la ratio de grasa entre la parte inferior del cuerpo y el tronco, con el porcentaje de riesgo de ECV a los 10 años, según la Escala de Riesgo de Framingham, y sus factores de riesgo (presión sanguínea sistólica, colesterol total y colesterol HDL, diabetes, y uso de medicación antihipertensiva), se realizaron usando modelos lineales generalizados, regresiones lineales y logísticas. Todos los análisis fueron estratificados por sexo y los ajustes se hicieron por edad, raza/color de piel autoinformado, nivel educativo, consumo de alcohol, actividad física durante el ocio, uso de medicamentos hipolipemiantes y, para mujeres, estatus menopáusico. En este estudio, un 55,91% fueron mujeres, con una media de edad de 52,68 (SD = 6,57) años. Una ratio de masa adiposa más alta entre las extremidades inferiores/tronco estuvo asociada a un riesgo menor de ECV en 10 años, también una reducción en la presión sistólica sanguínea, colesterol total, y el consumo de medicamentos antihipertensivos, también en un incremento del colesterol HDL en ambos sexos, pero esta relación fue más fuerte en mujeres. Asimismo, una relación protectora frente a la diabetes se observó solo en mujeres. Una acumulación más alta de grasa en las extremidades inferiores, comparada con la del tronco, parece tener un riego más bajo de ECV y sus factores de riesgo, incluso con la presencia de grasa en la región abdominal, además este efecto es más fuerte en mujeres comparadas con los hombres.

Racismo e iniquidade racial na autoavaliação de saúde ruim: o papel da mobilidade social intergeracional no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) / Racismo e inequidad racial en la autoevaluación de mala salud: el papel de la movilidad social intergeneracional en el Estudio Longitudinal de Salud de Adultos (ELSA-Brasil) / Racism and racial iniquities in poor self-rated health: the role of intergenerational social mobility in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Resumo: Pretos e pardos apresentam grandes desvantagens de saúde, possuem menores chances de ascensão na hierarquia social no curso de vida e menores níveis socioeconômicos do que brancos como resultado do racismo estrutural. Entretanto, pouco se sabe sobre o papel mediador da mobilidade intergeracional na associação entre racismo e saúde. O objetivo do presente estudo foi investigar a associação entre racismo e a autoavaliação de saúde, e verificar em que medida a mobilidade social intergeracional media essa associação. Estudo transversal realizado com dados de 14.386 participantes da linha de base (2008-2010) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Escolaridade materna, escolaridade do participante, classe sócio-ocupacional do chefe de família e classe sócio-ocupacional do participante compuseram os indicadores de mobilidade social intergeracional (educacional e sócio-ocupacional). Modelos de regressão logística foram utilizados. A prevalência de autoavaliação de saúde ruim foi de 15%, 24% e 28% entre brancos, pardos e pretos, respectivamente. Após ajustes por idade, sexo e centro de investigação foram encontradas maiores chances de autoavaliação de saúde ruim entre pretos (OR = 2,15; IC95%: 1,92-2,41) e pardos (OR = 1,82; IC95%: 1,64-2,01) quando comparados aos brancos. A mobilidade educacional e sócio-ocupacional intergeracional mediaram, respectivamente, 66% e 53% da associação entre a raça/cor e autoavaliação de saúde ruim em pretos, e 61% e 51% em pardos, respectivamente. Resultados confirmam a iniquidade racial na autoavaliação de saúde e apontam que a mobilidade social intergeracional desfavorável é um importante mecanismo para explicar essa iniquidade.

Resumen: Negros y mulatos presentan grandes desventajas de salud, poseen menores oportunidades de ascensión en la jerarquía social en el trascurso de su vida, y menores niveles socioeconómicos que los blancos, como resultado del racismo estructural. No obstante, poco se sabe sobre el papel mediador de la movilidad intergeneracional en la asociación entre racismo y salud. El objetivo de este estudio fue investigar la asociación entre racismo y autoevaluación de salud, así como verificar en qué medida la movilidad social intergeneracional interfiere en esa asociación. Se trata de un estudio transversal, realizado con datos de 14.386 participantes de la base de referencia (2008-2010) del Estudio Longitudinal de Salud de Adultos (ELSA-Brasil). La escolaridad materna, del participante, clase socio-ocupacional del jefe de familia y clase socio-ocupacional del participante compusieron los indicadores de movilidad social intergeneracional (educacional y socio-ocupacional). Se utilizaron modelos de regresión logística. La prevalencia de autoevaluación de mala salud fue de 15%, 24% y 28% entre blancos, mulatos/mestizos y negros, respectivamente. Tras los ajustes por edad, sexo y centro de investigación, se encontraron mayores oportunidades de autoevaluación de mala salud entre negros (OR = 2,15; IC95%: 1,92-2,41) y mulatos/mestizos (OR = 1,82; IC95%: 1,64-2,01), cuando se compara con los blancos. La movilidad educacional y socio-ocupacional intergeneracional mediaron, respectivamente, 66% y 53% de la asociación entre raza/color y autoevaluación de mala salud en negros, y 61% y 51% en mulatos/mestizos, respectivamente. Los resultados confirman la inequidad racial en la autoevaluación de salud y apuntan que la movilidad social intergeneracional desfavorable es un importante mecanismo para explicar esa inequidad.

Abstract: Blacks and Browns have major health disadvantages, are less likely to rise in the social hierarchy throughout the course of life, and pertain to lower socioeconomic levels than Whites as a result of structural racism. However, little is known about the mediating role of intergenerational mobility in the association between race/skin color and health. The aim of the present study was to investigate the association between racism and self-rated health and to verify to what extent intergenerational social mobility mediates this association. This was a cross-sectional study conducted with data from 14,386 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline (2008-2010). Maternal education, education of the participant, socio-occupational class of the head of household, and socio-occupational class of the participant were used in the indicators of intergenerational social mobility (educational and socio-occupational). Logistic regression models were used. The prevalence of poor self-rated health was 15%, 24%, and 28% among Whites, Browns, and Blacks, respectively. After adjustments for age, sex, and research center, greater chances of poor self-rated health were found among Blacks (OR = 2.15; 95%CI: 1.92-2.41) and Browns (OR = 1.82; 95%CI: 1.64-2.01) when compared to Whites. Intergenerational educational and socio-occupational mobility mediated, respectively, 66% and 53% of the association between race/color and poor self-rated health in Blacks, and 61% and 51% in Browns, respectively. Results confirm racial iniquity in self-rated health and point out that unfavorable intergenerational social mobility is an important mechanism to explain this iniquity.

The effect of laboratory testing on COVID-19 monitoring indicators: an analysis of the 50 countries with the highest number of cases. / O efeito da testagem laboratorial nos indicadores de acompanhamento da COVID-19: uma análise dos 50 países com maior número de casos.

OBJECTIVE: To analyse how testing the population influences the health indicators used to monitor the COVID-19 pandemic in the 50 countries with the highest number of diagnosed cases. METHODS: This was an ecological study using secondary data retrieved on 8/19/2020. Cumulative incidence, mortality rate, case-fatality rate, and proportion of positive tests were calculated. The data were described and presented graphically, with their respective Spearman Correlation Coefficients. RESULTS: The testing rate varied enormously between countries. Cumulative incidence and the proportion of positive tests were correlated with the number of tests, while the mortality rate and case-fatality rate showed low correlation with this indicator. CONCLUSION: Most countries do not test enough to ensure adequate monitoring of the pandemic, and this is reflected in the quality of the indicators. Expanding the number of tests is essential, but it needs to be accompanied by other measures, such as isolation of diagnosed cases and contact tracing.

The relationship between nutritional deficiencies and mental health

ABSTRACT The objective of this mini review was to discuss the relationship between nutritional deficiencies and mental health, and to present a structure that helps to visualize these associations based on a literature review and the scenarios of the COVID-19 pandemic. The study was conducted to demonstrate the effect of the nutritional deficiencies on the occurrence and/or worsening of mental health problems, mainly related to the most drastic measures of social distance during the COVID-19 pandemic. Studies have already shown that a nutritionally unbalanced diet may be associated with greater chances of mental health problems. Insufficient levels of micronutrients can, by regulating the stress response, immune and oxidative systems, negatively affect brain functions and, consequently, cognitive functions and mental health of individuals. The current pandemic of COVID-19 reveals an increase in food and nutritional insecurity, and a worsening of this situation among already vulnerable populations. Micronutrient deficiencies may be exacerbated in a context of increased food insecurity and the COVID-19 pandemic, which may contribute to increased mental health problems.

RESUMEN El objetivo de esta revisión fue discutir la relación entre las deficiencias nutricionales y la salud mental, y presentar una estructura que ayude a visualizar estas asociaciones con base en la revisión de la literatura y en los escenarios de la pandemia de COVID-19. El estudio se realizó para demostrar el efecto de las deficiencias nutricionales sobre la ocurrencia y/o agravamiento de problemas de salud mental, principalmente relacionados con las medidas más drásticas de distanciamiento social durante la pandemia COVID-19. Los estudios ya han demostrado que una dieta nutricionalmente desequilibrada puede estar asociada con mayores posibilidades de problemas de salud mental. Los niveles insuficientes de micronutrientes pueden, al regular la respuesta al estrés, los sistemas inmunológico y oxidativo, afectar negativamente las funciones cerebrales y, en consecuencia, las funciones cognitivas y la salud mental de las personas. La actual pandemia de COVID-19 revela un aumento de la inseguridad alimentaria y nutricional, y un agravamiento de esta situación entre poblaciones ya vulnerables. Las deficiencias de micronutrientes pueden agravarse en un contexto de mayor inseguridad alimentaria y la pandemia de COVID-19, lo que puede contribuir a un aumento de los problemas de salud mental.

O efeito da testagem laboratorial nos indicadores de acompanhamento da COVID-19: uma análise dos 50 países com maior número de casos / El efecto de las pruebas de laboratorio en los indicadores de seguimiento de COVID-19: un análisis de los 50 países con el mayor número de casos / The effect of laboratory testing on COVID-19 monitoring indicators: an analysis of the 50 countries with the highest number of cases

Objetivo: Analisar como a testagem da população influencia os indicadores de saúde usados para monitorar a pandemia de COVID-19 nos 50 países com maior número de casos diagnosticados. Métodos: Estudo ecológico sobre dados secundários, extraídos em 19/08/2020. Foram calculadas incidência acumulada, taxa de mortalidade, letalidade e proporção de testes positivos. Os dados foram descritos e apresentados graficamente, com o respectivo coeficiente de correlação de Spearman. Resultados: A taxa de testagem variou enormemente entre os países. A incidência acumulada e a proporção de testes positivos foram correlacionadas ao número de testes, enquanto a taxa de mortalidade e a letalidade apresentaram correlação baixa com esse indicador. Conclusão: A maioria dos países não testa o suficiente para garantir adequado monitoramento da pandemia, com reflexo na qualidade dos indicadores. A ampliação do número de testes é fundamental; porém, ela deve ser acompanhada de outras medidas, como isolamento de casos diagnosticados e rastreamento de contatos.

Objetivo: Analizar cómo el testeo poblacional influye en los indicadores de salud utilizados para monitorear la pandemia de COVID-19 en los 50 países con mayor número de casos diagnosticados. Métodos: Estudio ecológico, con datos secundarios, recogidos el 19/8/2020. Se calcularon la incidencia acumulada, la tasa de mortalidad, la letalidad y la proporción de pruebas positivas. Los datos fueron descritos y presentados gráficamente, con el respectivo Coeficiente de Correlación de Spearman. Resultados: La tasa de testeo varió enormemente entre los países. La incidencia acumulada y la proporción de pruebas positivas se correlacionaron con el número de pruebas, mientras que la tasa de mortalidad y de letalidad mostraron una baja correlación con este indicador. Conclusión: La mayoría de los países no realizan suficientes pruebas para garantizar un seguimiento adecuado de la pandemia, lo que se refleja en la calidad de los indicadores. La ampliación del número de pruebas es fundamental, y debe ir acompañada de aislamiento de casos y seguimiento de contactos.

Objective: To analyse how testing the population influences the health indicators used to monitor the COVID-19 pandemic in the 50 countries with the highest number of diagnosed cases. Methods:This was an ecological study using secondary data retrieved on 8/19/2020. Cumulative incidence, mortality rate, case-fatality rate, and proportion of positive tests were calculated. The data were described and presented graphically, with their respective Spearman Correlation Coefficients. Results: The testing rate varied enormously between countries. Cumulative incidence and the proportion of positive tests were correlated with the number of tests, while the mortality rate and case-fatality rate showed low correlation with this indicator. Conclusion: Most countries do not test enough to ensure adequate monitoring of the pandemic, and this is reflected in the quality of the indicators. Expanding the number of tests is essential, but it needs to be accompanied by other measures, such as isolation of diagnosed cases and contact tracing.

The effect of laboratory testing on COVID-19 monitoring indicators: an analysis of the 50 countries with the highest number of cases / El efecto de las pruebas de laboratorio en los indicadores de seguimiento de COVID-19: un análisis de los 50 países con el mayor número de casos / O efeito da testagem laboratorial nos indicadores de acompanhamento da COVID-19: uma análise dos 50 países com maior número de casos

Objective: To analyze how population testing influences the health indicators used to monitor the COVID-19 pandemic in the 50 countries with the highest number of diagnosed cases. Methods: Ecological study, with secondary data, downloaded on 8/19/2020. Accumulated incidence, mortality rate, case-fatality rate, and proportion of positive tests were calculated. The data were described and presented graphically, with the respective Spearman Correlation Coefficient. Results: The testing rate varied enormously between countries. The accumulated incidence and the proportion of positive tests were correlated with the number of tests, while the mortality rate and case-fatality rate showed a low correlation with this indicator. Conclusion: Most countries do not test enough to ensure adequate monitoring of the pandemic, reflecting on the quality of the indicators. The expansion of the number of tests is essential, but it needs to be accompanied by other measures, such as isolation of diagnosed cases and contact tracking.

Objetivo: Analisar como a testagem da população influencia os indicadores de saúde usados para monitorar a pandemia de COVID-19 nos 50 países com maior número de casos diagnosticados. Métodos: Estudo ecológico sobre dados secundários, extraídos em 19/08/2020. Foram calculadas incidência acumulada, taxa de mortalidade, letalidade e proporção de testes positivos. Os dados foram descritos e apresentados graficamente, com o respectivo coeficiente de correlação de Spearman. Resultados: A taxa de testagem variou enormemente entre os países. A incidência acumulada e a proporção de testes positivos foram correlacionadas ao número de testes, enquanto a taxa de mortalidade e a letalidade apresentaram correlação baixa com esse indicador. Conclusão: A maioria dos países não testa o suficiente para garantir adequado monitoramento da pandemia, com reflexo na qualidade dos indicadores. A ampliação do número de testes é fundamental; porém, ela deve ser acompanhada de outras medidas, como isolamento de casos diagnosticados e rastreamento de contatos.

Intake of selected foods and beverages and serum uric acid levels in adults: ELSA-Brasil (2008-2010).

OBJECTIVE: To investigate the association between the intake of selected food groups and beverages and serum uric acid (UA). DESIGN: Cross-sectional study using the baseline data (2008-2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Food intake was assessed by food frequency questionnaire with 114 items. Linear and logistic regressions investigated the associations between the daily intake of each food group (servings/d) and UA (mg/dl) and hyperuricemia (UA ≥ 6·8 mg/dl), respectively. All the analyses were adjusted for potential confounders, energy intake and all food groups. SETTING: Teaching and research institutions from six Brazilians states. SUBJECTS: The participants were 14 320 active and retired civil servants, aged 35-74 years. RESULTS: Higher intake of dairy products was associated with lower serum UA levels in both sexes, with a statistical dose-response gradient. High meat intake was associated with high UA only in women, and high intake of organ meats, in men. Intake of fish and fruits, vegetables and legumes were not associated with serum UA. In men, moderate and high intake of alcoholic beverages, specifically beer and spirits, but not wine, increased UA. In women, only high intake of alcoholic beverages, specifically beer, was associated with increased serum UA. Similar associations were seen for hyperuricemia. CONCLUSIONS: Results suggest a potential beneficial role of dairy products consumption on UA levels. The association between alcohol intake and UA differed according to type of beverage and between sexes. Results reinforce the need to consider the whole diet in the analysis and to conduct sex stratified analysis.

Imagem corporal e comportamentos relacionados à saúde em adultos: Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil), 2008-2010 / Imagem corporal e comportamentos relacionados à saúde em adultos: Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil), 2008-2010

Introdução:A imagem corporal vem sendo cada vez mais abordada na comunidade científica devido a sua relação com a obesidade e seu impacto de influenciar os indivíduos a adotar um estilo de vida saudável. Existem indícios de que a satisfação com a imagem corporal pode estar relacionada a hábitos como a prática de atividade física, assim como a percepção da imagem corporal pode se relacionar com diversos fatores ainda não muito bem definidos. Objetivos: A presente tese tem dois objetivos, a saber: 1) verificar se a insatisfação com a imagem corporal e o estado nutricional, indicado pelo índice de massa corporal e razão cintura/estatura, são independentemente associados com a intensidade da atividade física e se tal associação se difere entre homens e mulheres e; 2) investigar e descrever quais fatores podem estar relacionados à inacurácia da percepção do peso por meio da imagem corporal entre adultos. Metodologia: A amostra deste estudo é proveniente da linha de base do Estudo Longitudinal de Saúde do Adulto, composta por 15.105 adultos e idosos, servidores públicos em universidades federais e centros de pesquisa, localizados em seis estados brasileiros: Minas Gerais, São Paulo, Rio de Janeiro, Espírito Santo, Bahia e Rio Grande do Sul. Dois artigos foram desenvolvidos, cada um referindo-se a um dos objetivos. No primeiro artigo, a variável resposta foi o nível de atividade física, categorizado em 3 intensidades. Em uma população de adultos (35-64 anos), por meio de regressão logística, estimou-se a chance de praticar atividade física na presença das variáveis satisfação com a imagem corporal, índice de massa corporal e razão cintura/estatura. No segundo artigo, por meio de regressão logística, foi investigado quais fatores sociodemográficos, comportamentais e psicológicos estavam relacionados à percepção do peso por meio da imagem corporal na vida adulta de acordo com o sexo(35-64 anos). Resultados: No primeiro artigo, a insatisfação com a imagem corporal esteve presente mesmo entre indivíduos de peso normal de ambos os sexos e foi associado com menores chances de praticar atividade física moderada em mulheres e atividade física intensa em homens. Homens e mulheres com obesidade central foram menos propensos a praticar atividade física de intensidade moderada ou alta. Homens com sobrepeso e obesidade eram mais propensos a relatar a atividade física vigorosa enquanto mulheres obesas eram menos propensas a relatar este nível de atividade física. O segundo artigo apresenta que, em ambos os sexos, idade avançada, ex-fumantes e compulsivos alimentares foram associados com maiores chances de superestimar o peso, enquanto que maiores níveis educacionais estiveram relacionados com menores chances de subestimar o seu peso. Entre os homens, as chances de subestimar o peso também foram maiores naqueles que trabalhavam em ocupações não-manuais/rotineiras e naqueles com depressão; e menor em quem consumia álcool excessivamente. Nas mulheres, a menor escolaridade foi associada a maiores chances de subestimação, mas sem um gradiente consistente. Conclusões: Nossos resultados revelam que os indivíduos participantes provindos do estudo multicêntrico ELSA-Brasil possuem baixa consciência corporal e não praticam atividade física em suficientemente. A alta prevalência de sobrepeso e obesidade observada pode ter contribuído para a baixa percepção corporal. A insatisfação e inacurácia parecem se associar com comportamentos relacionados à saúde de forma negativa, como inatividade física, consumo de álcool e compulsão alimentar. Porém, é possível afirmar que a imagem corporal parece não se relacionar de forma tão robusta com os fatores incluídos nesse estudo, mas ela pode ser considerada um indicador de comportamentos não saudáveis e revelar a necessidade de mudanças no estilo de vida. É importante que os indivíduos tenham capacidade de distinguir entre o ideal de corpo preconizado pela mídia e o corpo que faz bem, que expressa uma vida saudável. Dessa forma, a percepção da imagem corporal pode contribuir para promover mudanças positivas nos hábitos de vida e outras medidas de controle de peso apropriadas e benéficas para a saúde e bem-estar.

Introduction:Body image has been increasingly discussed in the scientific community because of its relation to obesity and its impact to influence individuals to adopt a healthy lifestyle. There is evidence that satisfaction with body image may be related to habits such as physical activity, as well as the perception of body image may be related to several factors not yet well defined.Objectives:This thesis has two objectives, namely: 1) verify whether the dissatisfaction with body image and nutritional status, indicated by body mass index and the waist / height ratio, are independently associated with the intensity of physical activity and whether this association differs between men and women; 2)investigate and describe which factors may be related to the misperception of weight status among adults.Methodology:The sample of this study is from the baseline of the Brazilian Longitudinal Study of Adult Health, comprised of 15,105 adults and elderly, government employees from universities and research centers located in six Brazilian states: Minas Gerais, São Paulo, Rio de Janeiro, Espírito Santo, Bahia and Rio Grande do Sul. Two articles were developed, each referring to one of the goals. In the first article, the response variable was the level of physical activity, categorized into three intensities. In an adult population (35-64 years), by means of logistic regression, weestimated the chance to practice physical activity in the presence of the variables satisfaction with body image, body mass index and the waist / height ratio. In the second article, by means oflogistic regression, it was investigatedwhich sociodemographic, behavioral, anthropometric and psychological factors were related to the misperception of weight status in adulthoodaccording to sex(35-64 years).Results:In the first article, the body image dissatisfaction was present even among normal weight individuals of both sexes and was associated with lesser chances of practicing moderate physical activity in women and intense physical activity in men. Men and women with central obesity were lessprone to practice physical activity of high or moderate intensity. Overweight and obese men were more likely to report vigorous physical activity while obese women were less likely to report this level of physical activity. The second article presented that, in both sexes, older age, former smoking and binge eating were associated with greater chances of overestimating the weight, while higher educational level was related to less chances of underestimate their weight. Among men, the chances of underestimating the weight were also higher in non-manual/routine occupations and those with depression; and lower in heavy drinkers. In women, lower schooling was associated to greater chances of underestimation, but with no consistent gradient.Conclusions:Our results reveal that the participants from the multicenter study ELSA-Brazil have low body awareness and do not exercise sufficiently. The high prevalence of overweight and obesity observed may have contributed to the low body perception. Body image dissatisfaction and misperception of weight status seem to be associated with behaviors related to health in a negative way, such as physical inactivity, alcohol consumption and binge eating. However, it is clear that the body image does not seem to relate as robustly with the factors included in the study, but it can be considered an indicator of unhealthy behaviors and highlight the need for changes in lifestyle. It is important that individuals are able to distinguish between the ideal body advocated by the media and the healthy body. Thus, the accurate perception of body image can help promote positive changes in lifestyle and other appropriate weight control measures and beneficial to health and well-being.

[Evidence of the contribution of elderly support programs to healthy aging in Brazil]. / Evidências da contribuição dos programas de assistência ao idoso na promoção do envelhecimento saudável no Brasil.

OBJECTIVE: To search the literature for evidence of the contribution of elderly health programs to the process of healthy aging in Brazil. METHODS: The databases Science Direct, SciELO, LILACS, IBECS, the Cochrane Library, and MEDLINE were searched to find articles focusing on initiatives developed for the elderly population and to promote healthy aging, providing a multidimensional evaluation of the quality of life of the elderly, and covering aspects relating to specific health promotion practices. The initiatives were considered effective if the following criteria were met: having goals that included the improvement of health and well-being, having a focus on holistic health, using empowerment as a central mechanism to improve health, and meeting the prerequisites for health and developing actions in the priority areas described in the Ottawa Charter. RESULTS: Ten articles referring to five elderly health promotion programs in Brazil were identified. All the programs met the efficacy criteria, and included elements that promoted healthy aging through characteristics that fostered the insertion of the elderly in society through the creation of a support environment for the prevention of injury, increase in functional capacity, and improvement of quality of life. CONCLUSIONS: Studies are required to produce scientific evidence on the efficacy, efficiency, and effectiveness of elderly health programs to determine the value of these actions to promote healthy aging.

Evidências da contribuição dos programas de assistência ao idoso na promoção do envelhecimento saudável no Brasil / Evidence of the contribution of elderly support programs to healthy aging in Brazil

OBJETIVO: Buscar na literatura evidências relativas à contribuição dos programas de promoção da saúde no processo de envelhecimento saudável no Brasil. MÉTODOS: Pesquisaram-se as bases de dados Science Direct, SciELO, LILACS, IBECS, Biblioteca Cochrane e MEDLINE em busca de artigos que enfocassem iniciativas voltadas para a população idosa e o envelhecimento saudável, que avaliassem multidimensionalmente a qualidade de vida do idoso e que tratassem de aspectos relativos às práticas profissionais específicas em promoção da saúde. Para definir a eficácia das iniciativas, adotaram-se os seguintes critérios: ter metas que incluíssem a melhoria da saúde e do bem-estar; ter foco na saúde holística; usar o empoderamento como mecanismo central; atender os pré-requisitos da saúde e realizar ações nas áreas prioritárias da Carta de Ottawa. RESULTADOS: Foram identificados 10 artigos que se referiam a cinco programas de promoção da saúde do idoso no Brasil. Pode-se afirmar que todos os programas apresentados demonstraram elementos que vão ao encontro da promoção da saúde no envelhecimento por abranger características que permitem a inserção dos idosos na sociedade por meio da criação do ambiente de suporte para prevenção de agravos, aumento da capacidade funcional e melhoria da qualidade de vida, tendo sido atendidos os critérios de eficácia. CONCLUSÕES: É preciso produzir evidências científicas acerca da efetividade, eficiência e eficácia dos programas para a terceira idade para que se possa avaliar o valor dessas ações na promoção da saúde no envelhecimento.

OBJECTIVE: To search the literature for evidence of the contribution of elderly health programs to the process of healthy aging in Brazil. METHODS: The databases Science Direct, SciELO, LILACS, IBECS, the Cochrane Library, and MEDLINE were searched to find articles focusing on initiatives developed for the elderly population and to promote healthy aging, providing a multidimensional evaluation of the quality of life of the elderly, and covering aspects relating to specific health promotion practices. The initiatives were considered effective if the following criteria were met: having goals that included the improvement of health and well-being, having a focus on holistic health, using empowerment as a central mechanism to improve health, and meeting the prerequisites for health and developing actions in the priority areas described in the Ottawa Charter. RESULTS: Ten articles referring to five elderly health promotion programs in Brazil were identified. All the programs met the efficacy criteria, and included elements that promoted healthy aging through characteristics that fostered the insertion of the elderly in society through the creation of a support environment for the prevention of injury, increase in functional capacity, and improvement of quality of life. CONCLUSIONS: Studies are required to produce scientific evidence on the efficacy, efficiency, and effectiveness of elderly health programs to determine the value of these actions to promote healthy aging.